Retrorectus sublay mesh repair using polypropylene mesh: Cost-effective approach for laparoscopic treatment of ventral abdominal wall hernias

Abstract

Introduction:Laparoscopic repair of ventral abdominal hernias has become a standard of care. The surgery involves placement of a composite mesh with 3–5 cm overlap at the edges of the defect. The disadvantage of this repair is one, the composite mesh used for intraperitoneal placement is quite costly and two, it leaves a foreign body inside the peritoneal cavity, with the potential to cause problems in the future. To circumvent both these issues, we have developed a new approach, called the retrorectus sublay Mesh (RRSM) repair, which allows placement of a plain polypropylene mesh in an extraperitoneal plane.Patients and Methods:Patients with paraumbilical hernia and lower midline incisional hernias were included in this pilot study performed at a single centre by the same surgeon. The steps of the technique are described in detail.Results:Since 2016, a total of 52 patients were operated by this technique, including both male and female patients. It included patients with para-umbilical hernias as well as incisional hernias. The RRSM repair could be successfully carried out in all the patients. In six of the patients, transversus abdominis release was added as the defect size was large to allow closure of the defect. The results were satisfactory with a low morbidity and no mortality.Conclusion:In our opinion, the RRSM technique is an important tool in the armamentarium of the laparoscopic surgeon dealing with ventral abdominal hernias, allowing placement of polypropylene mesh in an extraperitoneal space. It allows significant cost savings as compared to the prevalent intraperitoneal onlay mesh repair.

Short‐ to Midterm Results After Posterior Component Separation with Transversus Abdominis Release: Initial Experience from India

“…Two of the papers providing the outcome of posterior component separation have come from a single center [4, 12] from the innovator of the technique itself and 14 more from other centers [6, 8–10, 13, 15–22, 30]. We found four papers on endoscopic PCS including one from Belyansky and others [24] and one from our center [23], seven papers on robotic and hybrid robotic PCS [8, 9, 31–36] and two on laparoscopic PCS [17, 37].…”

“…There is a significant enthusiasm in the Indian community about PCS. However, there are no studies on Indian population for the same except for 11 patients collaborated in the paper by Belyansky and others [24], some of whom underwent an RS repair without a PCS, 12 patients in a paper from our center [23] and 6 patient in a paper by Jani et al [17]. Our patient population and preoperative profile are similar to that in the earlier published papers [12, 13] except in terms of hernia defect size and BMI which are lower than most of these papers.…”

“…The large space created between TA and transversalis fascia (TF) allows for a large mesh placement, reinforcing a weak abdominal wall. Initial reports have shown encouraging short-and midterm results in the hands of the innovators and some early adopters [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. There are three reports containing data from \25 Indian patients [17,23,24].…”

“…Initial reports have shown encouraging short-and midterm results in the hands of the innovators and some early adopters [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. There are three reports containing data from \25 Indian patients [17,23,24]. Since the build, Body Mass Index (BMI), subcutaneous fat, and muscle mass of the Indian population are different from the western counterparts [25,26], it is imperative to evaluate the procedure in this population subgroup.…”

Comparison of efficacy and safety of the enhanced-view totally extraperitoneal (eTEP) and transabdominal (TARM) minimal access techniques for retromuscular placement of prosthesis in the treatment of irreducible midline ventral hernia

“…In Group B, 85.7% of the patients required 6 ports, whereas 14.3% of the patients were operated with only three ports with one-flap technique. [ 5 ]…”